Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC3574 | ID |
NPI | 1003006883 |
---|---|
Provider Name | Janice Webb Payne |
First Address | Hailey, ID 83333-3856 |
Second Address | Hailey, ID 83333-8440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 27/07/2007 |